Retiree Rate Charts (eff. 7/1/23)

• Contributory Retirement 
• New Hampshire Retirement 

Retiree Enrollment Forms

• Retiree Health Insurance Enrollment/Change Form 
• Retiree Dental Insurance Enrollment/Change Form

Plan Information

• SOS Summary of Benefits-Retirees from MWW
• SOS Summary of Benefits-Retirees from all other Departments 
• HDHP Open Access Network Summary of Benefits
• Anthem Out of State Plan (limited to retirees with residneces outisde of NE)
• Delta Dental Outline of Coverage
• Delta Dental Plan Booklet

Technology Resources

• Anthem Sydney Mobile App
• Anthem Member Portal
• Delta Dental Online Portal
• Delta Dental Mobile App 

Reimbursement and Discount Programs

• Vision Reimbursement
• Fitness Reimbursement
• Delta Dental Vision Discount Program
• Anthem's Special Offers

Away from Home Care Program

• Away From Home Care Program
• Away from Home Letter & Application Form
• Away From Home Care Participating States

Additional Resources

• Anthem's 24/7 Nurse Line
• Prescription Mail Order Form
• Anthem Individual Authorization Form
• Anthem Disabled Dependent Form